Thrombus Migration Just before Surgery

An 84-year-old woman was diagnosed with cardiogenic shock requiring emergent percutaneous coronary intervention. After emergency percutaneous coronary intervention, transthoracic echocardiography indicated a 30-mm mobile thrombus with the largest diameter of 35 mm in the left atrium (panel A). She was induced for urgent left atrial thrombectomy. Transesophageal echocardiography revealed that the left intra-atrial thrombus had migrated into the left ventricle passing through the aortic valve (panel B and Supplemental Digital Content video 1, https://links.lww.com/ALN/D62). Considering the size of the thrombus and the likelihood of entering carotid arteries, vascular echography was immediately performed and revealed a thrombus in the right common carotid artery. However, cerebral oximetry indicated that oxygen saturation decreased gradually from 77 to 62% in 30 min on the right side versus a constant reading of 40% on the left side. The atrial thrombectomy was abandoned, and an endovascular thrombectomy was performed instead, which confirmed the diagnosis....